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Plan Materials and Resources

Member Materials

2020 Annual Notice of Changes (ANOC) English Español 中文
2020 Summary of Benefits English Español 中文
2020 Evidence of Coverage English Español 中文
2020 Provider and Pharmacy Directory Bronx Brooklyn Manhattan Queens
2020 Formulary English Español
2020 Extra Help Premium Summary Table English Español 中文 (coming soon)
Multi-language Insert English Español 中文 Creole Русский Italiano 한국
Enrollment Form English Español 中文
Prescription Drug Claim Form English
Appointment of Representative Form English Español
Health Care Proxy Form & Information* English Español 中文 Creole Русский Italiano 한국
Part D Coverage Determination Form English
Member Reimbursement Form English (coming soon)
Part D Coverage Redetermination Form English (coming soon)
Prescription Drug Mail Order Form English
Privacy Notice English
Notice of Non-Discrimination English Español 中文 Creole Русский Italiano 한국
2020 Medicare Star Ratings English Español 中文 (coming soon)
Member Resources
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This page was last modified on October 15, 2019